Ester Carolina Apesoa-Varano

Curing and Caring: The Work of Primary Care Physicians With Dementia Patients

The symbolic framework guiding primary care physicians’ (PCPs) practice is crucial in shaping the quality of care for those with degenerative dementia. Examining the relationship between the cure and care models in primary care offers a unique opportunity for exploring change toward a more holistic approach to health care. The aims of this study were to (a) explore how PCPs approach the care of patients with Alzheimer’s disease (AD), and (b) describe how this care unfolds from the physicians’ perspectives. This was a cross-sectional study of 40 PCPs who completed semistructured interviews as part of a dementia caregiving study. Findings show that PCPs recognize the limits of the cure paradigm and articulate a caring, more holistic model that addresses the psychosocial needs of dementia patients. However, caring is difficult to uphold because of time constraints, emotional burden, and jurisdictional issues. Thus, the care model remains secondary and temporary.

Shards of sorrow: Older men's accounts of their depression experience

The experience of depression is diverse based on social locations and context. A sociological perspective building on masculinity, illness work, and the self provides a useful theoretical framework to understand how older men negotiate emotional suffering. This article examines older mens accounts of their depression experience from a social constructionist approach. This analysis is based on data from 77 in-depth interviews with depressed older men who participated in a larger mixed-method study, the Mens Health and Aging Study (MeHAS). We show how older men construct depression accounts in which they integrate biological and social factors associated with feeling a loss of control. This is experienced as a shamed masculine self given their inability to perform manhood acts, which leads them to severe social bonds. Mens accounts also shed light on how they resist the shaming of the masculine self by deploying two primary strategies: acting overtly masculine through aggressive behavior and by retracting from social interactions that may lead to feelings of shame. These strategies appear futile and they are only partially able to embrace alternative masculine values in line with roles as grandparents and older, wiser men. Depression in older men is characterized by an ongoing negotiation of limited statuses and roles given dominant conceptions of masculinity.

Falling through the cracks: gaps in depression treatment among older Mexican-origin and white men.

This study aims (i) to compare depression frequency and self‐reported depression treatment in Mexican‐origin and white men; (ii) to examine ethnic differences in self‐reported prior depression diagnosis and types of treatment; and (iii) to determine whether Mexican‐origin men (both English and Spanish language preferring) are less likely than white men to report receiving depression treatment after controlling for potential confounders.

A descriptive qualitative study of the roles of family members in older men's depression treatment from the perspectives of older men and primary care providers

The aim of this study is to describe the roles of family members in older mens depression treatment from the perspectives of older men and primary care physicians (PCPs).

Interprofessional conflict and repair: A study of boundary work in the hospital

This article is about boundary work and the accomplishment of work among various groups claiming professional status at the bedside in the hospital. The author analyzes qualitative data from 110 in-depth interviews and participant observation with physicians, nurses, respiratory therapists, social workers, and occupational, physical, and speech therapists. The findings show how work roles, and hence occupational boundaries, are flexible and malleable. Practitioners usually cross these boundaries within reason, and thus boundary work engenders ironic dualities; it generates both conflict and cooperation, questioning and affirmation, and that is why most reasonable work role transgressions do not fundamentally undermine the social order of the hospital. Boundary work provides insights on the dynamic nature of professionalism as the outcome of a negotiated order that reveals itself at the ideological and behavioral levels. Understanding how and why boundary work is done also has policy implications at the workplace and health care service levels.

How family members manage risk around functional decline: The autonomy management process in households facing dementia

Most dementia research investigates the social context of declining ability through studies of decision-making around medical treatment and end-of-life care. This study seeks to fill an important gap in research about how family members manage the risks of functional decline at home. Drawing on three waves of in-depth interviewing in 2012-2014, it investigates how family members in US households manage decline in an affected individuals natural range of daily activities over time. The findings show that early on in the study period affected individuals were perceived to have awareness of their decline and routinely drew on family members for support. Support transformed when family members detected that the individuals deficit awareness had diminished, creating a corresponding increase in risk of self-harm around everyday activities. With a loss of confidence in the individuals ability to regulate his or her own activities to avoid these risks, family members employed unilateral practices to manage the individuals autonomy around his or her activity involvements. These practices typically involved various deceits and ruses to discourage elders from engaging in activities perceived as potentially dangerous. The study concludes by discussing the implications that the social context of interpretive work around awareness and risk plays an important role in how families perceive an elders functional ability and manage his or her activity involvements.

Mexican-American Families and Dementia: An Exploration of “Work” in Response to Dementia-Related Aggressive Behavior

Managing dementia-related behavioral problems at home is of significance for both care-recipients and caregivers as well as more generally for public health. Examining how Mexican-American families respond in the home when the person with dementia displays aggressive behavior provides a unique opportunity to understand how they accomplish the work involved in managing illness. The aims of this study were (a) to describe the socio-cultural context in which dementia-related aggressive behavior takes places, and (b) to describe the work that Mexican-American families do to manage dementia-related aggressive behavior. This is an ethnographic study involving participant observation of Mexican-American families caring for a person with dementia at home. Findings show that there is variation in how families accomplish illness work when dementia-related aggressive behavior disrupts everyday caregiving. The types of work performed by families under these strenuous and stressful situations likely result from a confluence of gender and generational differences.

Idioms of Distress Among Depressed White-Non-Mexican and Mexican-Origin Older Men

Older men are less likely than older women to receive depression treatment. Latino older men in particular have been found to have significantly lower rates of depression treatment than their white-non-Mexican (WNM) counterparts. Prior research has shown that men are less likely than women to express overt affect and/or report depression symptoms that may prompt primary care physicians’ inquiry about depression. Previous studies have overlooked the idioms of distress common among older men. This study investigates: a) the range of idioms of distress that emerge in the narratives of depressed older men, and b) the use of these idioms among depressed WNM and Mexican-origin older men. The present report is based on qualitative data collected through the Men’s Health and Aging Study (MeHAS), a mixed-method study of clinically depressed WNM and Mexican-origin older (65 and above) men recruited in primary care settings. Qualitative analysis of 77 interviews led to identification of idioms of distress and informed idiom categories. Study findings show that: a) both groups of men utilized a range of idioms of distress that met current DSM criteria for depression, b) both groups were also likely to utilize idioms that feel outside clinical depression criteria, and c) there were similarities as well as differences between WNM and Mexican-origin men. This study provides a larger vocabulary that clinicians might consider in recognizing depression and initiating depression care for older men from diverse ethnic backgrounds. This is important to improve depression care among older men in general and those of Mexican-origin in particular.

Medication takeovers: Covert druggings and behavioral control in Alzheimer's

Older adults consume the most prescription medication in the U.S. For those who develop Alzheimers disease, risk of medication misuse increases with the progression of the disease. Family members commonly intervene to lessen risks by taking over the management and administering of a medication regimen. Despite the potential for grave harm around the misuse of powerful drugs, few studies provide insight into the household social context of medication use for this disease. Drawing on 60 in-depth interviews conducted in four waves over 2.5 years, this study investigates how family members administered prescription and over-the-counter medications to elders with Alzheimers. The findings detail how family members initially created and enacted the role of proxy-administrator to avoid self-administration errors and then expanded the role to manage disruptive behaviors. During this process, family members perceived themselves as working in partnership with doctors, especially in the effort to craft a regimen that controlled the affected individuals mood and sleep/wake cycle. The paper concludes by discussing the implications that family members used medications to improve conformity to a preferred household social order. The study offers conceptual advances in understanding 1) the process of proxy-administration in Alzheimers care and 2) the role of proxy-administrators in the medicalization of deviant behavior.

Dementia Informal Caregiving in Latinos: What Does the Qualitative Literature Tell Us?

In the next few decades, the number of older Latinos with Alzheimer’s disease and related dementias will increase dramatically. Latino families, who provide a substantial amount of caregiving in the home for kin with degenerative brain disease, will face the challenges of care provision at a time when intergenerational support is changing. The goal of this study was to systematically review the qualitative literature on caregiving of Latinos with ADRD in order to identify key themes and opportunities to advance the field. We found that sociocultural context and processes are fundamental in our understanding of informal caregiving for dementia in Latinos. The literature has provided descriptions of the experience of Latino caregivers (e.g. costs, burden, and rewards) as well as their views and knowledge of the disease. However, there is a gap in the literature regarding how we evaluate Latino caregivers’ perceptions against their actual behavior. A gap also exists in the lack of longitudinal research (both quantitative and qualitative) in order to identify changes over time, pivotal events, and causal pathways shaping the ADRD Latino caregiver trajectory. This is important in advancing research to address those gaps and in translating the existing knowledge into meaningful policy and intervention work.